Mental health in the Black community: Access, safety, and well-being

October 28, 2021 - 17 min read

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What is the mental health stigma in Black communities?

4 factors that affect mental health in Black communities

Ideas about mental illness that reinforce stigmas

Barriers to mental health care in the Black community

Changing the stigma about mental health

Whether at home or at work, safety — both physical and psychological — is a key component of mental health. But in the Black community, safety isn’t a given. Multiple factors — systemic racism, lack of representation, restricted access, and social stigma — converge to create a crisis. This article explores some of the contributing factors, racial disparities, and factors that impact mental health in the Black community.

What is the mental health stigma in Black communities?

The stigma around mental health in the Black community dates back at least as far as slavery. For slave owners, Black people were seen as less evolved than white people, and therefore not capable of developing mental health disorders like depression. On the other hand, Black people didn’t have the luxury of ontological inquiry into their mental state. As illustrated in Maslow’s hierarchy of needs, basic needs like food, shelter, safety, and survival would have superseded the ability to treat mental health. Applying what we know about stress and the impact it has on well-being, the chronic stress that characterized a life of slavery relentlessly eroded both physical and mental well-being.

4 factors that affect mental health in Black communities

Slavery has ended, but that hasn’t guaranteed safety for the Black community or for people of color. Since the emancipation of slaves in the United States, each subsequent generation has had to fight for marginal improvements in safety, wealth, and opportunity. Because of the lack of physical and psychological safety, Black people haven’t had the luxury of falling apart. The odds of survival rewards those who can endure, and so the mantra has become “move forward at any cost.” 

Moving forward has become the default setting for many people of color, who have been carrying the stress of racial trauma, socioeconomic disparity, and the pressure to hide any sign of weakness for generations. After learning to suppress the trauma for so long, it becomes safer to act as if it doesn't exist then it is to unpack it. Many conversations about Black history are buried under this discomfort, since to acknowledge the pain is to acknowledge the deeper feelings of hopelessness that are underneath it. However, these buried emotions – coupled with lack of access to mental health resources and ongoing sociopolitical strife – leave African-Americans at high risk for serious psychological distress.

Because of this, the state of mental wellness in the Black community is precarious at best. Several factors compound generations of unhealthy coping mechanisms, born out of the need to adapt and survive at all costs. Black adults are 20% more likely to experience mental health disorders, including major depression and anxiety disorders. They report feeling down, hopeless, sad, anxious, feeling like everything is an effort, and other symptoms of emotional distress at significantly higher rates than the general population. However, they are less likely to receive support, with only 1 in 3 people receiving mental health care for these symptoms.

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Systemic racism

Clinical associate professor Ruth White at the University of Southern California notes that “In the African American community, mental health issues are often compounded by the psychological stress of systemic racism.” Systemic race inequality poses a threat to physical safety, psychological safety, and economic security

Black people are at risk from the institutions that supposedly exist to protect them. Black people are 3.5 times more likely to be killed by the police, even when they are unarmed, complying with their requests, or not attacking. Black Americans are incarcerated at approximately 5 times the rate of white Americans, and are more likely to receive harsher sentencing for similar crimes.

Wealth is not an insulating factor. Black people are just as likely to be profiled and killed by police even if they are affluent. These racial disparities also exist in the health care system. Black mothers are three times more likely to die as a result of childbirth than their white counterparts, largely due to habitual dismissal and lack of attention from medical professionals, even when they are insured or members of the medical community.

If that wasn’t enough, systemic racism poses barriers to accumulating wealth and reaching important financial milestones like home ownership. Black households earn lower salaries and hold a fraction — around a tenth — of the wealth that white families have. They are less likely to own homes, face discrimination in hiring practices, and are more likely to be turned down for loans and access to credit. When Black families are able to purchase homes, they are often subject to redlining, predatory lending practices, and higher insurance rates than white homeowners. 

Additionally, Black mental health is affected by:

Lack of community and connection to culture

One of the great tragedies of slavery in the United States was the loss of connection to African American culture. Due to incomplete record-keeping during slavery ,consistent name changes, and efforts to separate families, many Black Americans who can trace their lineage to slavery are unable to go back any further. That means that part of the experience of being Black in the United States is not knowing where you came from. 

The stressors that the Black community faces, namely, the pressure to assimilate, make it difficult to bond over culture. The idea that in order to survive, one must distance themselves from their Blackness is prevalent and deeply ingrained in Black American society. Even gatherings of Black people are easy targets for overzealous policing. It’s safer, then, to dissociate from the social connections that would insulate against depression and loneliness.

Intersectionality

Blackness is but one facet of identity. Many Black people also belong to other communities and traditions. Some are Latinx, half-white, members of the LGBTQ+ community, female, immigrants, or any number of other identities. This can complicate the experience of being Black — particularly in the United States, where the Black identity is fraught with so many long-standing connotations. 

In some cases, belonging to multiple marginalized groups can compound the danger experienced by a single individual. For example, Black transgender people are twice as likely to be killed or victims of violent crimes as white cisgender people.

Epigenetics

A growing field of research called epigenetics has indicated that the effects of trauma can actually be passed on from generation to generation. The field still has more research and testing to do, but if current findings can be extrapolated to the experience of human beings, generations of suffering, racism, disparity, and violence against Black bodies has literally been encoded in the genetics of the African-American experience. 

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Ideas about mental illness that reinforce stigmas

Because strength has become a prerequisite for surviving in a hostile world, the Black community has become skilled at minimizing and disguising weaknesses. This coping mechanism, though, can quickly become toxic, as in the stereotype of the “strong Black woman.” This schema is both a way of dealing with discrimination and a reclaimed artifact of slavery, where slave masters justified brutal punishments by reasoning that Black people “didn’t feel pain.”

In order to be successful, to be seen as “good enough,” or just to get into the room, Black people have had to be exceptional. Despite their accomplishments and qualifications, Black candidates are less likely to be hired for roles than white candidates (or candidates with white-sounding names). That leaves no room for personal weakness or flaws that might further complicate getting onto stable ground. Black people are taught to hide or suppress difficult feelings, making them a source of shame and embarrassment when they do arise. If you can’t keep it together, it’s because you weren’t strong enough.

This characterization of strength as a virtue is a double edged sword for people of color. On one hand, it lends them the fortitude to deal with microaggressions, chronic threat, and a playing field littered with jagged inequities. On the other, it makes Black people less likely to ask for help — and less trusting of it when it is available.

Barriers to mental health care in the Black community

Aside from the cultural stigmas around mental health, the Black community faces several issues around access to and quality of medical care. Black people (and other communities of color) are less likely to have health insurance coverage, making the costs of medical and mental health care untenable (especially when taking into account statistically lower salaries and savings). 

Even when insurance coverage isn’t an issue, Black people are wary of receiving medical treatment. As the National Alliance on Mental Illness (NAMI) notes, “Provider bias, both conscious and unconscious, and a lack of cultural competency can result in misdiagnosis and inadequate treatment.” This issue, which also compounds the mortality rate for physical conditions and birth complications, has an impact on mental health diagnoses. NAMI’s statistics show that Black men are more likely to be diagnosed with schizophrenia when reporting symptoms consistent with mood disorders or PTSD. 

Hesitancy and distrust of medical professionals in the Black community has received intermittent attention over the years, coming to light recently in the push for the COVID-19 vaccination. Many people who delayed getting vaccinated cited a history of barbaric treatment from the medical community (the Tuskegee syphilis experiment is an aptly-referenced example). With mental health treatment, there is a fear that reaching out for treatment will leave Black people further exposed — to mistreatment and misdiagnosis from clinicians, or to ostracism and further reduced opportunities from the larger community.

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The representation issue

Decades and centuries of discrimination, both overt and covert, have taught Black people to distrust white people. It was a mere generation ago that segregation laws mandated racial separation. Integration was accompanied by a lingering feeling of dis-ease that was passed to current generations. As people learn to interact with one another, acknowledging the impact of racism while searching together for a path forward, issues of safety and implicit bias complicate the issue. A well-meaning white coworker, friend, or colleague can trigger a generation of trauma with a poor comment or joke.

Because Black people are underrepresented in the medical community, this leaves them at a distinctly uncomfortable crossroads when it comes to seeking behavioral health treatment. A poll taken following the death of George Floyd indicated that 41 percent of Black people were experiencing symptoms of anxiety and depression. Yet, only 2% percent of psychiatrists and 4% of psychologists are Black. Black people, then, overwhelmingly have to make the choice to see a non-Black (in most cases, white) therapist for their mental health needs.

Should this matter? Well, in a perfect world, no. But it’s important that therapeutic settings are as safe as possible. Just as we offer people the choice of a male or female doctor because we know that one might make them feel safer, we should acknowledge that choice when it comes to race. Overwhelmingly, Black people (as well as members of the LGBTQ+ community and other marginalized groups) find themselves spending a significant amount of time in therapy justifying and explaining racial, political, and social trauma to disbelieving mental health providers.

This experience underscores the need for culturally competent care — that is, training within the mental health community on intersectionality and how to relate to people who have (multiple) identities that are distinct from their health provider. As Jacy Topps notes in their Glamour editorial:

And so any conversations surrounding the wellness of marginalized people simply must include the impact of oppression, of social systems that harm them, and of white supremacy.

Changing the stigma about mental health

One of the best ways to change misconceptions about mental health is to amplify resources and organizations dedicated to serving the Black community. Here’s a list of some of these groups:

Black Men Heal offers limited and selective free mental health service opportunities for Black men.

Black Mental Health Alliance provides information and resources, along with a “Find a Therapist” locator to connect with a culturally competent mental health professional.

Black Women’s Health Imperative advances health equity and social justice for Black women through policy, research, and advocacy.

Inclusive Therapists seeks to provide identity affirming, culturally responsive care to all people, with all abilities, in all bodies.

LGBTQ Psychotherapists of Color Directory and the National Queer and Trans Therapists of Color Network provide representative support for people who are members of both the Black and LGBTQ+ communities.

NAMI Sharing Hope is a one-hour program to increase mental health awareness in Black communities through sharing the presenters’ personal experiences with mental health conditions. NAMI also offers a more extensive list of resources on the Identity and Cultural Dimensions page.

The American Psychological Association offers some resources for working with Black clients and racial trauma. Here are the APA Best Practices, a list of APA Mental Health Facts for Black Americans (2017), and the APA Stress & Trauma Toolkit.

Breaking down the stigma

Working with Black people in a therapeutic or mental health setting requires awareness and education. For many people, if they’re reaching out for help, they’re doing so in spite of and amidst social, emotional, and cultural pressure telling them to do otherwise. Breaking down the stigma around mental health in the Black community can’t be done overnight. It happens in one-on-one conversations, every day, with the commitment to show up bravely, be seen, and to learn.


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Published October 28, 2021

Allaya Cooks-Campbell

BetterUp Staff Writer

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